Policy Implications

Combining public and private settings could produce broader and more balanced clinical competence. Expanding eligibility to people just above current income thresholds could further reduce disparities. Public centres provide high patient volumes and case diversity, while private centres provide modern equipment access, hands-on participation, and feedback. The findings emphasize persistent disparities despite substantial maternal and child health progress. Social and economic dynamics can increase care-seeking in one settlement while reducing it in another. Nepal's CKD financial protection framework leaves significant residual costs unaddressed. Further algorithm training, Community Health Officer evaluation and cost-effectiveness analysis are needed before large-scale policy decisions. The study cautioned that generalisation requires care because contextual inequalities differ by place. Improving access requires better availability of appropriate paediatric formulations because affordability was not the binding constraint. Neighbourhood conditions were interpreted as important alongside individual vulnerability. Progress slowed during the SDG era, possibly because of investment l…